Let’s clear something up: traditional couples counseling is not considered a covered benefit under most insurance plans.

There is not a workaround or a billing trick; it’s a matter of medical necessity. Insurance plans are structured to pay for treatment of a diagnosable mental health condition, not to cover sessions focused solely on improving a relationship.

But here's where many providers get confused. What looks like "couples counseling" on the surface may, in fact, be a medically necessary session focused on one individual’s diagnosis with their partner participating to support that treatment.

This distinction isn’t just semantics. It’s a compliance line that matters in both documentation and billing.

So, What’s Covered?

Covered:

• Therapy that targets a specific mental health diagnosis (e.g., anxiety, PTSD, depression)
• The involvement of a partner or family member to support treatment goals
• Clear identification of the client of record and their diagnosis
• Use of appropriate CPT codes for individual therapy or family therapy as applicable to reason for session (e.g., 90834 or 90837 or 90846 or 90847)

Not Covered:

• Sessions focused on the relationship itself (e.g., resolving communication issues, marital conflict, intimacy)
• No diagnosis or treatment plan tied to a specific individual
• Sessions where both parties are treated as equal clients without a primary diagnosis guiding the work

Documentation is Everything

If your therapy session includes a patient’s partner, the documentation must make one thing clear:
You are treating the patient’s behavioral health condition, not the couple’s relationship.

Here’s what solid documentation includes:

• Who the identified patient is
• The diagnosis being treated
• The treatment goals tied to that diagnosis
• The role of the partner as a support person, not a second client

✅ Audit-Ready Note Example:

“Client’s partner participated in the session to learn and practice DBT skills focused on distress tolerance techniques outlined in the treatment plan. Client reported increased emotional regulation at home since partner began assisting with skill use.”

❌ Audit-Risky Note Example:

“Discussed recent arguments between client and partner and explored strategies for better communication.”

What About CPT Codes 90846 and 90847?

This code represents family psychotherapy with the patient present, but many payers limit its use. It can only be used when:

• The therapy is aimed at treating that individual’s condition
• Family involvement is necessary to support treatment outcomes

90847 is not a stand-in for couple’s therapy. And using it to try to get reimbursed for non-covered services is risky.

Don’t Document Yourself into Trouble

Phrases to avoid in documentation when the service is truly addressing a condition, billed under therapy codes as intended as part of treatment plan and involves the spouse:

• “Couples counseling”
• “Marriage therapy”
• “Relationship-focused session”
• “Conflict resolution between partners”

Instead, use language that reflects clinical necessity and therapeutic intent for the patient, such as:

• “Partner present to support treatment interventions”
• “Spouse participated in skill-building per treatment plan goal”
• “Session focused on patient's anxiety management with support from partner”

The Bottom Line

If your goal is to treat the relationship, insurance won’t likely pay for it, and they shouldn’t. But if your goal is to treat a patient’s behavioral health condition, and you involve their partner as support in that process, there is a path forward. That path must be compliant, clinically sound, and clearly documented.

Final Thoughts:

This isn’t about gaming the system. It’s about knowing what you’re doing and documenting what’s actually happening in the room. If it is couples therapy, then there is no “making” it something it is not.

Train your staff to understand this distinction, especially those handling documentation and billing. Missteps, however unintentional, can lead to recoupments, denials, or worse.